Kern County Employee Benefits: Health Benefits

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Employee Health Benefits

Eligibility

The following persons, and their dependents, are eligible for coverage: 1) Elected officials or persons employed and paid for their services by the County who work at least half-time and whose compensation is not fixed at a rate by the day, hour or meeting. 2) Personnel eligible for COBRA coverage. 3) Those persons designated by Board of Supervisor action, and, 4) Retirees.

picture of family

Eligible Dependents

Dependents include the legal spouse or unmarried child of an employee/retiree who is not in the military and lives in the United States. The child must be under age 19 or a full time student/dependent (age 19, 20, 21, or 22), or an over-age disabled dependent. Full-time is generally defined as being enrolled with at least 12 college or university units at all times. Student eligibility in a non-college situation is evaluated on a case-by-case basis.

Eligibility Date

Employees are eligible for coverage the first day of the bi- weekly period coincident with or next following the day the employee completes one month of continuous service.

Effective Date of Benefits

An employee's benefits become effective on the employee's eligibility date.

When Benefits End

Benefits, as an employee will end on the last day of the bi-weekly payroll period during which employment ends. Benefits will also end on the due date of any unpaid employee contribution.

Cost

The employee share of the cost of health benefits will be determined by the appropriate Memorandum of Understanding. All County employees hired before April 15, 1997 have health benefits provided at no cost to the employee. For most bargaining units, the employee share of cost for employees hired on or after April 15, 1997 is 20% of the current bi-weekly premium cost. Employee contribution amounts can be obtained from the CAO - Health Benefits Division.

COBRA

A Federal Law, usually called COBRA, requires that most employers sponsoring group health plans offer employees and their families the opportunity for a temporary extension of health coverage (called "continuation coverage") at group rates in certain instances where coverage under the plan would otherwise end. Employees covered by the County's health benefits programs have a right to choose this continuation coverage if they lose health insurance coverage because of a reduction in hours or the termination of employment for reasons other than gross misconduct.

The spouse of an employee covered by the County's health benefits programs has the right to choose continuation coverage if health coverage is lost for any of the following four reasons:

Death of spouse;
Termination of spouse's employment (for reasons other than gross misconduct) or reduction in spouse's hours of employment;
Divorce or court ordered legal separation from spouse; or
Spouse becoming entitled to Medicare.

In the case of a dependent child of an employee covered by health benefits, he or she has the right to continuation coverage if group health coverage is lost for any of the following five reasons:

The death of a parent;
The termination of a parent's employment (for reasons other than gross misconduct) or reduction in a parent's hours of employment with the Employer;
Parents' divorce or court ordered legal separation;
A parent becomes entitled to Medicare; or
The Dependent ceases to be eligible.

A child who is born to or placed for adoption with a covered employee during a period of continuation coverage will be deemed a qualified beneficiary (eligible) for COBRA coverage. The newborn or adopted child must be added to COBRA coverage within the time frame and with the appropriate forms provided for active employee coverage.

Under COBRA, the employee or a family member has the responsibility to inform the County of a divorce, court ordered legal separation under which the employee wishes to cancel any spouse or dependent coverage, or a child losing dependent eligibility within 60 days of the happening of any such event. If notice is not received within that 60-day period, the dependent will not be entitled to choose continuation coverage.

When the County is notified that one of these events has happened, the County or COBRA administrator will in turn, send notice of the right to choose continuation coverage. Under COBRA, the participant has at least 60 days from the date of loss of coverage, due to one of the events described above, to inform the County that continuation coverage is wanted.

If continuation coverage is not chosen, group health coverage will end effective at midnight of the last day of the bi-weekly payroll period during which the employee terminated employment.

If continuation coverage is chosen, the County is required to give coverage which, as of the time coverage is being provided, is identical to the coverage provided to similarly situated employees or dependents. COBRA requires that participants be afforded the opportunity to maintain continuation coverage for 36 months unless group health coverage was lost because of termination of employment or reduction in hours. In that case, the required continuation coverage period is 18 months. Participants may be charged up to 102% of the applicable premium for the continuation coverage on a monthly basis.

If, during that 18-month period, another event takes place that would also entitle a spouse or dependent child (other than a spouse or child who became covered after continuation coverage became effective) to his or her own continuation coverage (for example, the former Employee dies, is divorced or legally separated, or becomes entitled to Medicare, or a dependent ceases to be eligible), this continuation coverage may be extended. However, in no case will any period of continuation coverage be more than 36 months.

If an employee, employee's spouse, or dependent child is determined to be disabled under the terms of the Social Security Act as of the date employment terminated (or the date hours were reduced), the disabled person is eligible for an additional 11 months of continuation coverage after the expiration of the 18-month period. To qualify for this additional period of coverage, the disabled person must notify the County within 60 days after receiving a determination of disability from the Social Security Administration, provided notice is given before the end of the initial 18 months of continuation coverage.

During the additional 11 months of continuation coverage, the cost for that coverage will be approximately 50% higher than it was during the preceding 18 months.

COBRA also provides that continuation coverage may be cut short for any of the following four reasons:

The County no longer provides group health coverage to any of its employees;
The cost for continuation coverage is not paid in a timely fashion;
Coverage commences under another group health plan, unless that other plan contains an exclusion or limitation with respect to any preexisting condition affecting the employee or a covered dependent; or
A participant becomes entitled to Medicare.

Demonstration of good health is NOT required to choose continuation coverage. However, under COBRA, the participant may have to pay all or part of the cost for continuation coverage. There is an initial grace period of 45 days, starting with the date continuation coverage is chosen, to pay any costs.

COBRA continuation coverage is not effective until the enrollment process is completed and the initial premium is paid. After that initial 45-day grace period, there is a grace period of at least 30 days to pay any subsequent cost. COBRA also says that, at the end of the 18-month or 36-month continuation coverage period, enrollment must be allowed in any individual conversion health plan which may be provided. However, the County does not have any individual plans available.

Any questions about COBRA should be directed to the CAO-Health Benefits division at (661) 868-3182 or the COBRA administrator, The Lynn Company, at (661) 873-2200. Also, any changes in marital status, Dependent eligibility, or address should be sent to the CAO-Health Benefits division.

Dental Plans

Group Dental coverage is provided to employees and their eligible dependents who are enrolled in the medical plan. The County has two dental insurance options for employees. One is a pre-paid plan which works very much like an HMO in medical insurance; that is, there is a relatively small panel of providers from which to choose, the participant selects a dentist from the panel and the dentist gets paid a fixed monthly fee per enrollee regardless of the amount of care delivered. Costs to the employee for care are very low. This pre-paid program is currently known as Liberty Dental Plan DHMO (formerly Pacific Union Dental).

The other dental option for employees is called Independence PPO Dental administered by Liberty Dental (formerly UHC PPO). It is a 'Preferred Provider' plan under which the patient can obtain service either from a Preferred Provider dentist (with the plan paying 90%) or any other dentist with lower benefits paid by the plan

Medical Plan Summary

On Jun. 1st 2006, American Administrative Group (formerly Gallagher Benefits Administrators) began administering the County's medical plan. To contact American Administrative Group, you can either:

a)	call (866) 568-KERN (5376)
b)	visit the custom Web site they created for Kern County. The Web site address is on your medical card. On this site, you may search for providers, download forms, and connect to dental, vision, and pharmacy websites.

Prescription Drugs

When employees and eligible dependents are covered under the medical plan, they are issued a prescription card, with which to obtain covered prescriptions at reduced rates. Prescriptions may be obtained at CatalystRx participating pharmacies for $5, $15, or $30 for a 30-day supply, or through Walgreen's Mail Service Pharmacy (Tempe location) for $10, $30, or $60 for a 90-day supply.

Vision Plan

Group vision insurance coverage is provided to employees and their eligible dependents who are enrolled in the medical plan. The vision plan is provided through VSP. The program provides for an eye examination every twelve months, and lenses and frames once every twenty-four months. If your lens prescription changes before you are eligible for new lenses and these prescription changes meet the following criteria, lenses and frames may be replaced at a 12 month frequency instead of a 24 month frequency.

an axis change of 20 degrees or a .50 diopter cylinder change.
a new prescription would improve visual activity by at least one line on a standard eye chart.

Participants are responsible for a $20.00 co-payment to the participating doctor for the eye examination and an additional co-payment of at least $20 for lenses and/or frames. Benefits are reduced if a non-VSP-member doctor is used.

This is only a basic summary of health benefits. Eligibility and benefit questions should be directed to the CAO-Health Benefits Division at (661) 868-3182.

WELLNESS AND EMPLOYEE ASSISTANCE

Employee Wellness Program (EWP)

The Employee Wellness Program is available to County employees who qualify for regular health benefits. Participating employees will receive a Personal Wellness Profile, a variety of health screenings and classes. Screenings include cholesterol, glucose, blood pressure, height and weight measurements. Core Classes include: weight management (6 sessions); smoking cessation (4 sessions); Nutrition and fitness (1 session); stress management (2 sessions); coronary risk factors (1 session). Optional classes (1 session each); high blood pressure, cholesterol management; diabetes management, and asthma control.

The program facilitator is Bakersfield Family Medical Center ("BFMC"). For more information call Sylvia Mora at BFMC at (661) 846-4653.

Employee Assistance Program (EAP)

This program is available to health benefits eligible employees and their family members. The purpose of the EAP is to provide evaluation and, if appropriate, short term counseling for behavioral problems which affect work performance or personal life. Through a confidential self-referral process, employees have the opportunity to discuss their personal situation in strict confidence with an understanding professional. Examples of issues that may be dealt with are: marital; family; children; alcohol abuse; drug abuse; persistent anxiety; post-traumatic stress; battered spouse; depression; and financial/legal referral service. A County department head may make a formal referral is he or she feels and employee's job performance might benefit from the services provided by the EAP. When a formal referral is made by management, it is strongly recommended that employees follow through. Information that is discussed during counseling sessions is strictly confidential and will not be made available to the County. To make an appointment call Alan Pevar & Associates at (661) 322-4000 or 1-888-KERN-EAP.

Last Modified
9/19/2008

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